Noble Care

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the continuation of the required annual visit at 11:13 AM. LPA met with facility staff who contacted facility Administrator Armine Tagaryan. The Administrator arrived to the facility at 11:23 AM. Entrance interview conducted and the reason for the visit was explained. The following was observed: RECORD REVIEW: Record review began at 11:25 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Four (4) staff files were reviewed. All staff files contained all required documents and trainings. Five (5) resident files were reviewed. All resident files contained all required documentation and signatures. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:56 PM. Medications for five (5) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Continued on LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 07/16/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. The residents interviewed had no concerns with the facility. LPA interviewed two (2) staff members. The staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse No deficiencies were observed during today’s inspection. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 02:11 PM. LPA met with facility staff who contacted facility Administrator Armine Tagaryan. The Administrator arrived to the facility at 02:23 PM. Entrance interview conducted and the reason for the visit was explained. Beginning at 02:24 PM, the LPA, along with the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a secured cabinet located under the sink to contain cleaning supplies. BEDROOMS: There are five (5) bedrooms in the facility; two (2) resident bedrooms are dual occupancy rooms and two (2) resident rooms are single occupancy rooms. One (1) bedroom is designated as a staff room. LPA and facility Administrator toured all four (4) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The staff room was observed to be locked and inaccessible to residents in care. Report Continued on LIC 809-C BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms, and one (1) bathroom is designated as a staff bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in resident showers and near resident toilets, all were properly secured. The water temperature was measured between 112.8 and 113.1 degrees Fahrenheit, which is in compliance with regulation. The staff bathroom was observed to be clean and appliances appeared to be in good condition. COMMON AREAS: This includes the living room, hallway, and dining room The living room was observed to be clean and in good repair. The living room contained adequate seating, a television, and activities for resident use. LPA observed a hallway closet to contain extra care supplies. LPA observed cameras in the common areas of the facility, LPA confirmed with the Administrator that audio is not recorded. LPA observed the dining room to be clean and properly furnished at the time of the visit. The dining room contained a dining table with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms and fire door were tested at 02:52 PM and were functional at the time of the visit. GARAGE: LPA observed the garage to be inaccessible to clients in care. The garage contained a washer and dryer, emergency water supplies, and extra care supplies. LPA observed a storage room attached to the garage to contain an extra refrigerator and freezer and an adequate emergency food supply. OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the front yard; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed an appropriately fenced off pool that was inaccessible to residents in care. LPA observed cameras throughout the outdoors of the facility. Due to time constraints LPA will return at a later date to conduct file review, medication review, and interviews. During today’s visit LPA obtained copies of the facility’s LIC 500, resident roster, and current liability insurance. No deficiencies were observed during today’s inspection. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 16, 2025

Allegation investigated: Staff do not properly feed resident in care. Staff do not ensure resident is provided fluids. Staff leave resident in bed for extended periods of time. Staff isolates resident in care.

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 09:04 AM. LPA met with the facility Administrator Armine Tagaryan the reason for the visit was explained and entrance interview was conducted. During today’s visit LPA conducted a physical plant tour, interviewed residents, interviewed facility staff, interviewed the facility Administrator and conducted file review between 09:05 AM and 11:36 AM. The allegation of “Staff do not properly feed resident in care” alleges that facility staff do not provide enough food to Resident #1 (R1) to meet their dietary needs. LPA conducted a physical plant tour of the facility and observed the facility’s pantry and refrigerator to be fully stocked. LPA observed a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. Continued on LIC 9099C. Unsubstantiated At 09:05 AM LPA observed facility staff delivering breakfast to residents in care. R1’s family member (Witness #1) was interviewed via telephone call. W1 had no concerns with the amount or quality of food being served to R1. LPA interviewed Staff #1 (S1). S1 stated that residents get three (3) meals a day with snacks in between if requested, S1 has never denied a request from a resident for additional food. LPA reviewed R1’s medical records which contained no information to indicate malnutrition. LPA interviewed R1 who stated that they get enough food. Based on the information obtained during the physical plant tour, record review, and interviews there is not sufficient evidence to support the allegation of Staff do not properly feed resident in care. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff do not ensure resident is provided fluids” alleges that facility staff do not ensure that R1 is provided with a sufficient amount of fluids. During the physical plant tour LPA observed the refrigerator to be stocked with juices and other drinks. LPA interviewed R1 who stated that they get enough juice when they ask. LPA interviewed Resident #2 (R2) and Resident #3 (R3). Both residents stated that they receive enough fluids and that drinks are provided by staff when requested. During breakfast LPA observed the trays to contain juice and/or coffee. During S1’s interview they confirmed that residents are provided with liquids when requested. Based on the information obtained during the physical plant tour and interviews there is not sufficient evidence to support the allegation of Staff do not properly feed resident in care. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff leave resident in bed for extended periods of time” alleges that facility staff do not move R1 from their bed for extended periods of time. During the physical plant tour LPA observed R1 in their bed. The facility Administrator approached R1 to introduce LPA prior to the interview. The facility Administrator attempted to move R1’s arm and R1 exclaimed, “Don’t move me!” LPA then interviewed R1 who stated that they do not like to be moved. R1 stated that they wish facility staff would leave their head alone as they do not like it when staff attempt to reposition their neck. LPA asked R1 if they ever ask staff to take them out of bed and R1 replied, “I don’t want to get out of bed.” Continued on LIC 9099C. LPA spoke with W1, they stated that they wished R1 would be moved more but they expressed understanding that R1 does not wish to be moved and stated that they know movement causes R1 pain. During LPAs interview with S1 they stated that R1 has never asked them to be moved from the bed. S1 confirmed that they reposition R1 in bed every three (3) hours. LPA interviewed the facility Administrator, they confirmed that R1 does not like being moved. The Administrator stated that in the past they have moved R1 from their bed to a recliner located in the living room via Hoyer lift. R1 would only sit in the chair for a minute before requesting to be placed back in their bed due to pain. The Administrator stated that R1 complains every time they attempt to move or reposition them. R2 is R1’s roommate. R2 stated that they have observed facility staff attempting to move R1 in the past. R2 stated that R1 tells facility staff not to move them often. Based on the information obtained during observation and interviews there is not sufficient evidence to support the allegation of Staff leave resident in bed for extended periods of time. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff isolates resident in care” alleges that facility staff isolate R1 for extended periods of time. During the investigation LPA observed facility staff attending to R1 and other resident’s needs. LPA interviewed R1 who stated that their family is allowed to visit them. R1 stated that facility staff attend to them enough to take care of them. During the interviews with R2 and R3 both residents stated that the facility staff are kind and attentive to their needs. Neither resident had concerns about being isolated. S1 stated during their interview that they attend to all residents throughout the day and respond to resident requests quickly when called. The facility Administrator denied isolating the resident. The Administrator stated that they respond to the resident’s requests when asked and they allow family to visit whenever they want. W1 has never been denied from visiting R1 and did not express any concerns about R1 being isolated. Based on the information obtained during interviews there is not sufficient evidence to support the allegation of Staff isolates resident in care. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. No deficiencies were cited during today’s investigation. A copy of the report was printed and exit interview was conducted.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 29-AS-20241017092856

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a continuation of the required annual visit at 12:34 PM. LPA met with facility staff who contacted facility administrator Armine Tagaryan. Administrator arrived to the facility at 01:42 PM. Entrance interview conducted and the reason for the visit was explained. During today’s visit LPA conducted a brief physical plant tour, interviews, and medication review. INTERVIEWS: LPA interviewed one (1) resident and two (2) staff between 12:45 PM and 01:05 PM. The resident interviewed stated that the staff are nice and are attentive to their needs. The resident had no concerns with the facility. Both staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedure for suspected abuse. Both staff interviews were conducted with the assistance of the administrator acting as a translator. MEDICATION REVIEW: Beginning at 01:06 PM LPA and the facility administrator conducted medication review for five (5) of five (5) residents. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. Medications are stored centrally and securely in a storage cabinet in the staff office. No deficiencies were observed during medication review. No deficiencies were observed during today’s visit. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 2, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 12:58 PM. LPA met with facility staff who contacted facility administrator Armine Tagaryan. Administrator arrived to the facility at 01:05 PM. Entrance interview conducted and the reason for the visit was explained. Beginning at 01:05 PM, the LPA, along with facility administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives as well as a secured cabinet located under the sink which contained cleaning supplies. BEDROOMS: There are four (4) bedrooms in the facility; one (1) is a dual occupancy room and two (2) are single occupancy rooms. One (1) bedroom is designated as a staff room. LPA and facility administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Two (2) resident beds were observed to contain full bed rails. Auditory alarms were observed on facility exits and all were functional at the time of the visit. The staff room was observed to be locked and inaccessible to residents in care. Report Continued on LIC 809-C Continued from LIC 809-C BATHROOMS: There are three (3) bathrooms at the facility. Two bathrooms are designated as shared resident bathrooms, and one (1) bathroom is designated as a staff bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in resident showers and near resident toilets, all were properly secured. The water temperature was measured between 108.7 and 114.4 degrees Fahrenheit, which is in compliance with regulation. The staff bathroom was observed to be clean and appliances were observed to be in good condition. COMMON AREAS/GARAGE: This includes the living room and dining room. LPA observed the dining room to be clean and properly furnished at the time of the visit. The dining room contains a dining table with adequate seating for resident use. The living room was observed to be clean and in good repair. The living room contained adequate seating and activities for resident use. LPA observed a hallway closet to contain extra care supplies. LPA observed the garage to contain a washer and dryer, emergency water supplies, and extra care supplies. LPA observed cameras in the common areas of the facility, LPA confirmed with the administrator that audio is not recorded. The facility’s combination fire and carbon monoxide alarms were tested at 02:48 PM and were functional at the time of the visit. OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the front yard; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed an appropriately fenced off pool that was inaccessible to residents in care. RECORD REVIEW: Record review began at 01:47 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, TB tests, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed all resident files contained all required documentation. No deficiencies were observed during record review. Report Continued on LIC 809-C Continued from LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly the facility’s last emergency disaster drill was conducted on 09/05/2024. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. INTERVIEWS: LPA interviewed one (1) resident. the resident interviewed stated that the staff treat them well and are attentive to their needs. The resident had no concerns with the facility. Due to time constraints LPA will return at a later date to conduct medication review and staff interviews. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 1, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required Annual inspection at 10:00 a.m. The LPA met with Administrator Armine Tagaryan and explained the reason for the visit. The LPA, and the administrator toured the inside and outside of the facility to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 75 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. One fire extinguisher was fully charged and was last serviced 08/30/2023. The LPA observed required postings throughout the common space. KITCHEN: Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for six residents, and two staff. The hot water temperature measured at 110.5 degrees Fahrenheit. BEDROOMS: Facility has four (4) bedrooms. One bedroom is shared, and three (3) bedrooms are private. Bedrooms were furnished appropriately with appropriate furnishings, bedding, and sufficient lighting. BATHROOMS: The facility has three (3) bathrooms. Two bathrooms are for residents, and one bathroom for staff, and visitors. The shower areas were in clean condition with grab bars and non-skid mats available. Soap, and paper towels were available for drying hands. Hand washing signs were displayed.The hot water temperature measured at 110.5 degrees Fahrenheit. Continues on LIC 809C... OUTDOOR SPACE: The LPA observed the backyard of the facility to be free of clutter and debris. Outdoor furniture and a shaded area are available for residents. There is a pool which is fenced in, and inaccessible from residents. RECORDS: Records review began at 11:45 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:30 p.m.; medications are centrally stored and locked in a file cabinet in the office area; medications are labeled and were checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 5, 2023